Healthcare Provider Details

I. General information

NPI: 1982938056
Provider Name (Legal Business Name): SONIA PORTUGAL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2009
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 WASHINGTON ST
POUGHKEEPSIE NY
12601-2303
US

IV. Provider business mailing address

58 S MANHEIM BLVD APT 38
NEW PALTZ NY
12561-2464
US

V. Phone/Fax

Practice location:
  • Phone: 845-790-7990
  • Fax:
Mailing address:
  • Phone: 646-327-8824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number093152
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: